India’s Superhospitals And Superbugs

By Sonia Shah

Source: Le Monde Diplomatique

Saturday, January 05, 2013

Through the later 20th century, patients from developing countries came to western hospitals seeking high-tech medical care unavailable at home. That flow has started to reverse. With costs in countries such as the US increasing sharply, and waiting times in Europe getting longer, patients from the West now go to developing countries for cheap, quick medical care no longer accessible at home, in a booming medical tourism industry valued at $60bn worldwide. This year, reports the Deloitte Centre for Health Solutions, over 1.6 million Americans will go on “scalpel safaris” to lower costs and avoid queues.

Advocates of medical tourism claim that Indian surgeries should be seen as a boon for ailing western healthcare systems, a kind of medical outsourcing, equivalent to the call centres that have allowed western companies to cut service costs by 40% or more (2). Western insurance companies such as Blue Cross Blue Shield and Aetna seem to agree. Both have quietly added hospitals in India and in the developing world to their lists of covered providers (3).

‘We should set our own house in order’

But questions on the ethics of providing sophisticated medical care for foreigners while many ordinary Indians lack access to basic health services go unanswered (4). “We should set our own house in order rather than cater to foreigners,” said New Delhi surgeon Samiran Nundy, a prominent critic of the privatisation of healthcare in India. India spends around 1% of its GDP on public health, one of the lowest rates in the world. Fewer than half of India’s children are fully immunised, and a million Indians die every year from treatable tuberculosis and preventable diarrhoeas. Medical expenses drive nearly 40 million Indians into poverty every year (5).

Drug-resistant bacteria are a global problem, with bugs such as MRSA (methicillin-resistant staphylococcus aureus) plaguing western hospitals. But medical tourism, poverty and government policy in India make the spread of NDM-1 worrying. The first NDM-1 infection was spotted in 2008 in a Swedish patient who had recently been hospitalised in India. In 2009 the UK national health service issued a warning that patients in the UK who had been hospitalised in India and Pakistan had NDM-1 infections. In 2010 three cases of NDM-1 infection were discovered in the US. All three patients had received medical treatment in India (8). Since then, NDM-1 infections have been discovered in 35 countries, in many cases tied to medical tourism to India. There is also evidence that NDM-1 bacteria have started to spread more widely, infecting people with no history of travel to South Asia.